How some Democratic holdouts made the call on healthcare

For some lawmakers, the decision on how to vote was a deeply personal one. Here's how three ultimately came to support the legislation.

Reporting from Washington — When crunch time came on President Obama's healthcare initiative, the pressure on Democratic holdouts came from almost everywhere -- from Air Force One and the House speaker's suite, from blaring television ads and anxious constituents.

But for Rep. Dale E. Kildee, the last word came in a Catholic rectory, during a quiet morning hour of meditation and counsel that ended with a priest laying both hands on the Michigan Democrat's head in a blessing.

For Kildee, who spent six years in seminary as a young man, support for the bill was contingent on its banning federal funding for abortion. He studied the text. He absorbed criticism for waffling. He consulted like-minded colleagues. But he was not sure what to do until he took the question to his priest, who, despite other church leaders' opposition, told him the bill was true to his antiabortion commitment.

"We are on good grounds to support the bill," Kildee said after the pastoral meeting.

In the run-up to Sunday's climactic vote, abortion was just one issue and Kildee was just one of the dozen or so House Democrats who did not reach their decisions until the final week.

But Kildee's experience underscores a striking fact about how these pivotal decisions were finally made.

For all the stereotypes about how Washington works -- about Lyndon Johnson-style arm-twisting and horse-trading -- what moved many of these lawmakers was not so much backroom threats and promises.

Rather, it was substantive changes in the legislation, from parochial details to large matters of conscience.

To get the final votes they needed from the widely diverse Democratic caucus, party leaders kept tweaking and changing the massive legislation to make specific provisions acceptable to individual members -- always mindful that each change could win one vote but lose another.

It was like trying to twist a kaleidoscope but control what the new picture would look like.

From the beginning of the epic debate more than a year ago, the vast majority of House Democrats have been strong supporters of a far-reaching healthcare overhaul.

But as the final decision came in sight last week, a significant number of them -- including some backbenchers, abortion opponents and fiscal conservatives -- still had not made the journey to "yes" from "no" or "maybe."

And in most cases, House Speaker Nancy Pelosi (D-San Francisco) and her lieutenants had little leverage outside the bill, with each concession to win a holdout carrying the unnerving possibility of unraveling all that had gone before.

Spending curbs that helped win over fiscal conservatives alienated liberals; shifting Medicare funding to one region penalized others; the abortion compromise that prevailed in the Senate endangered the bill in the House.

For the holdouts, it was not a simple journey. And each had to follow a different path.

Here are the stories of three of them:

Too far right

Rep. Dan Maffei, whose strong ties to labor helped him win a swing district in upstate New York in 2008, had voted for the House bill last year. But he was dismayed by the more conservative Senate version, which became the only path to healthcare legislation once Democrats lost their filibuster-proof supermajority in the Senate.

His labor backers were bitterly opposed to the tax on high-end "Cadillac" plans. Changes in Medicaid, the state-federal health program for the poor, would penalize New York. And medical device manufacturers, a major employer in his district, were fighting a tax on their industry.

Maffei migrated from "no" to "maybe" after Obama proposed scaling back the Cadillac tax. When the reconciliation bill to modify the Senate measure was written, about $2 billion was added back for New York on Medicaid. The medical device tax was postponed.

Maffei talked to Phil Schiliro, Obama's chief lobbyist and a friend from before the 2008 election, when the two were senior congressional aides. With that history, Maffei felt free to complain about the administration's hands-off strategy of leaving the legislation to Congress until the end.

"They needed to be more involved much sooner," said Maffei, who welcomed Obama's decision this month to put off a planned trip to Asia.

When Obama called, he sold Maffei on the idea that defeat of the healthcare bill would be such a setback that many of the nation's other problems would fester, untouched, for years to come.

Maffei gave his word to the president, flew home, and announced his position in East Syracuse. "While the reform process isn't pretty, we've debated this bill long enough," he said. "In fact, we've talked about reforming healthcare for decades. Doing nothing is no longer an option."